London, January 10, 2019. The National Institute for Health and Care Excellence (NICE) evaluates guidelines for health technologies, clinical care practices, and prevention on behalf of the UK Department of Health. These guidelines are primarily based on an analysis of effectiveness and cost-effectiveness. NICE assesses whether new treatment methods offer added value compared to other treatments that are not used when the new therapy is implemented.
In a draft assessment of erenumab for migraine prevention, NICE states that erenumab (Aimovig) is not cost-effective. The guideline analyzed erenumab for the prevention of chronic and episodic migraine in adults who experience four or more migraine episodes per month and for whom at least three other preventive treatments have been ineffective.
NICE believes the available studies demonstrate that erenumab is a clinically effective treatment. However, the committee concluded that the studies do not reflect the spectrum of patients treated in the healthcare system. Furthermore, the studies do not provide the necessary comparative data with existing medications. For this reason, stricter standards than usual are applied to the cost-effectiveness assessment when there is uncertainty regarding the evidence of efficacy.
In view of the severe disability caused by migraine, the director of NICE stated that it was disappointing that NICE was unable to issue a positive recommendation for erenumab because of this fact.
There is insufficient evidence to suggest that erenumab is more effective than botulinum toxin type A for the treatment of chronic migraine. For both chronic and episodic migraine, there is no evidence that erenumab is sustainably effective in patients for whom three previous treatments with other drugs have been ineffective.
NICE will work with the manufacturer to give it the opportunity to address the issues raised in this preliminary recommendation.
It is estimated that 190,000 migraine attacks are suffered daily in England, and that women are affected more often than men (5-25% versus 2-10%).
Typically, three different classes of drugs are tried unsuccessfully before further specialized treatment is considered. For patients with chronic migraine who have had at least three previous treatment attempts fail, NICE has recommended botulinum toxin type A as a treatment option.
An overview of erenumab can be found here:
https://schmerzklinik.de/2018/11/29/erenumab-aimovig-ein-neuer-wirkansatz-in-der-migraeneprophylaxe-durch-immuntherapie-mit-antikoerper/
literature
https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence
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